Dr. Murai Éva szerk.: Parasitologia Hungarica 24. (Budapest, 1991)

Lb case. Slight mental deterioration was mainly observed in adults, but could sometimes be noticed in children as well. Neuritis. In one patient coronarography was performed because of serious chest pain, another was operated on because of suspicion of gastric perforation, and in a third case surgery was performed because of symptoms resembling vertebral disc herniation. The pain - which was the leading symptom in almost every case seldom was so serious. Migrating paresthesia, numbness, fluctuating headache, fatigue and sleeplessness usually rose the suspicion of neurotic syndrome in the physicians. Paresthesias were rarely accompanied by severe paresis. Complete paraplegia developed in three cases only. Reflex asymmetry could be demonstrated in half of the patients with neuritis. Cranial nerves other than the facial nerve were seldom involved. The eye movements were restricted in 17 cases. Progressive borreliosis. Only one of our patients met the strict criteria of progressive borreliosis. The diagnosis was undoubtedly proved by the success of therapy (72). Arthritis In five cases, acute arthritis developed while ECM could still be seen. All had large joint involvement. In one patient gonarthritis preceded ECM. In the region of the involved knee a tick had been found ten days (!) earlier. ECM developed in the same region two weeks after the tick bite. When arthritis developed after a short incubation time, mainly large joints were swollen. In those patients who had arthritis in two months after tick bite or ECM large and small joints were equally involved. In cases of a longer incubation period small joint inflammation predominated (Fig. 6). A significant difference was found in the median incubation time between large, mixed (large and small) and small joint arthritis. It was 66, 137 and 302 days, respectively. In 102 patients, arthritis was the only sign of Lb. Temporomandibular arthritis was observed in five cases. The relapsing-remitting course of joint inflammation was especially characteristic of the large joint arthritis. The highest number of relapses (six) were observed in a patient who had chronic synovitis in the knee. He remained therapy resistant despite treatment with high doses of antibiotics (iv. penicillin, doxycycline, ceftriaxone). Occasionally, arthralgia preceded the frank arthritis. The time that elapsed between the onset of arthralgia and of frank arthritis was highly variable, the shortest being 3 days and the longest up to 3 years. In some cases arthralgia persisted as long as 5 years after the improvement of frank arthritis. In many cases - sometimes during, or shortly after the treatment - large joint arthritis was followed by small joint inflammation. Pregnancy and borreliosis Only three borrelia infections were diagnosed during pregnancy. ECM developed in the third trimester in two cases and facial palsy appeared in the second